Fields of Dreams Summer Camp 2026

Please fully complete this form. All fields marked with * must be filled. Completing this application does not guarantee a slot.

If you'd rather use a paper copy, pick one up at Turner ES or call Keith Stubbs at (240) 463-9904.

Student

Student's Name

Date of Birth

Address

City

State

Zip

Ward

Gender

Race / Ethnicity

Current School Attending

Entering Grade (SY 2026–2027)

Must be entering 3rd–6th — no exceptions.

Parent / Guardian

Parent / Guardian Name

Parent / Guardian Address (if different from student)

Home Number

Cell Number

Work Number

You'll receive a confirmation email here.

Emergency Contact

Emergency Contact Name

Relationship

Address

Phone Number

Alternate Phone Number

Pickup & Authorization

Does your child walk home?

Yes No

Will you or an authorized adult pick up at 4:30 PM?

Yes No

Authorized Adults — staff will not release your child to any adult not listed below without a confirmed parent note.

Authorized Adult #1 — Name & Contact #

Authorized Adult #2 — Name & Contact #

Medical

Any medical, physical, or mental health needs that require special attention?

Medications your child takes regularly

Food allergies

Do you consent for your child to receive medical attention in the event of an emergency?

Yes No

Fields of Dreams Connection

Is your child currently a Fields of Dreams participant at Turner ES?

Yes No

Parent / Guardian Statement

Read the full statement

I hereby give permission for my child to participate in all activities conducted by the Fields of Dreams (FOD) Summer Program, including educational activities at the school site, performing and visual arts activities at the school site, field trips to arts and educational activities away from the school site, and sports activities conducted in DCPS and/or DC Dept. of Parks and Recreation facilities.

I further grant permission for my child: (1) to appear in person and in voice, video, or photographic presentation for non-commercial radio, television, internet, or print media reports and/or media campaign(s) resulting from participation in this program and its activities, (2) to complete confidential or anonymous surveys, and (3) to participate in interviews for evaluation purposes.

By signing this application, I am certifying that my child is in normal health (or if there is a medical problem, it is indicated above) and able to participate in all FOD activities. By signing below, I am authorizing FOD staff to act for me in securing medical treatment for my child in the event of injury or sickness during the program. I assume all risks and hazards related to this program and absolve the Fields of Dreams' staff and volunteers of any liability for any injury to my child.

I recognize that transportation will not be provided and I understand that if my child is not picked up from the camp site by 5 PM, he/she may be taken to the Office of Child Protective/Emergency Services located at 200 I Street, SE, (202) 671-SAFE. I also grant permission for my child to be transported to field trips of the program.

I have read and agree to the Parent / Guardian Statement above.

Type your full name as signature

Your typed full name is your e-signature.

Date

Printed name of person signing

Relationship to child

Please check the box above accepting the Parent / Guardian Statement to submit your application.

After you submit, you'll get a confirmation email at the address you provided.

✓

Application received!

Thanks for applying to Fields of Dreams Summer Camp 2026.

We've emailed a confirmation to —.

What's next: Camp slots are limited. If your child is accepted, you'll receive an email with orientation materials and you'll be asked to confirm enrollment. Please do not assume your child has been accepted just because your application was received.

Questions? Contact Keith Stubbs at (240) 463-9904 or email keith.stubbs22@gmail.com.

2026 Summer Camp at Anita J. Turner ES

Student

Parent / Guardian

Emergency Contact

Pickup & Authorization

Medical

Fields of Dreams Connection

Parent / Guardian Statement

Application received!